@article{WaltherWesselMalbergetal.2006,
  author    = {Walther, T and Wessel, Niels and Malberg, Hagen and Voss, Andreas and Stepan, H and Faber, R},
  title     = {A combined technique for predicting pre-eclampsia : concurrent measurement of uterine perfusion and analysis of heart rate and blood pressure variability},
  year      = {2006},
  abstract  = {Objective Pre-eclampsia is a serious complication of pregnancy with high morbidity and mortality and an incidence of 3-5\% in all pregnancies. Early prediction is still insufficient in clinical practice. Although most pre- eclamptic patients have pathological uterine perfusion in the second trimester, perfusion disturbance has a positive predictive accuracy (PPA) only of approximately 30\%. Methods Non-invasive continuous blood pressure recordings were taken simultaneously via a finger cuff for 30 min. Time series of systolic as well as diastolic beat-to-beat pressure values were extracted to analyse heart rate and blood pressure variability and baroreflex sensitivity in 102 second- trimester pregnancies, to assess predictability for pre-eclampsia (n = 16). All women underwent Doppler investigations of the uterine arteries. Results We identified a combination of three variability and baroreflex parameters to best predict pre-eclampsia several weeks before clinical manifestation. The discriminant function of these three parameters classified patients with later pre-eclampsia with a sensitivity of 87.5\%, a specificity of 83.7\%, and a PPA of 50.0\%. Combined with Doppler investigations of uterine arteries, PPA increased to 71.4\%. Conclusions This technique of incorporating one-stop clinical assessment of uterine perfusion and variability parameters in the second trimester produces the most effective prediction of pre-eclampsia to date},
  language  = {en}
}
@article{PortaDiRienzoWesseletal.2009,
  author    = {Porta, Alberto and Di Rienzo, Marco and Wessel, Niels and Kurths, J{\"u}rgen},
  title     = {Addressing the complexity of cardiovascular regulation},
  issn      = {1364-503X},
  doi       = {10.1098/rsta.2008.0292},
  year      = {2009},
  language  = {en}
}
@article{MalbergWesselHasartetal.2002,
  author    = {Malberg, Hagen and Wessel, Niels and Hasart, Annett and Osterziel, Karl Joseph and Voss, Andreas},
  title     = {Advanced analysis of the spontaneous baroreflex sensitivity, blood pressure and heart rate variability in patients with dilated cardiomyopathy},
  year      = {2002},
  abstract  = {Baroreflex sensitivity (BRS) is an important parameter in the classification of patients with reduced left ventricular function. This study aimed at investigating BRS in patients with dilated cardiomyopathy (DCM) and in healthy subjects (controls), as well as comparing the values of BRS parameters with parameters of heart rate variability (HRV) and blood pressure variability (BPV). ECG, continuous blood pressure and respiration curves were recorded for 30 min in 27 DCM patients and 27 control subjects. The Dual Sequence Method (DSM) includes the analysis of spontaneous fluctuations in systolic blood pressure and the corresponding beat-to-beat intervals of heart rate to estimate bradycardic, opposite tachycardic and delayed baroreflex fluctuations. The number of systolic blood pressure/beat-to- beat interval fluctuations in DCM patients was reduced in comparison with controls (DCM patients: male, 154.4+/-93.9 ms/ mmHg; female, 93.7+/-40.5 ms/mmHg; controls: male, 245.5+/-112.9 ms/mmHg; female, 150.6+/-55.8 ms/mmHg, P<0.05). The average slope in DCM patients was lower than in controls (DCM, 5.3+/-1.9 ms/mmHg; controls, 8.0+/-5.4 ms/mmHg; P<0.05). Discriminant function analysis showed that, in the synchronous range of the standard sequence method, the DCM and control groups could be discriminated to only 76\% accuracy, whereas the DSM gave an improved accuracy of 84\%. The combination of six parameters of HRV, BPV and DSM gives an accuracy of classification of 96\%, whereas six parameters of HRV and BPV could separate the two groups to only 88\% accuracy. Thus the DSM leads to an improved characterization of autonomous regulation in order to differentiate between DCM patients and healthy subjects. BRS in DCM patients is significantly reduced and apparently less effective.},
  language  = {en}
}
@article{FaberBaumertStepanetal.2004,
  author    = {Faber, R. and Baumert, M. and Stepan, H. and Wessel, Niels and Voss, Andreas and Walther, T.},
  title     = {Baroreflex sensitivity, heart rate, and blood pressure variability in hypertensive pregnancy disorders},
  issn      = {0950-9240},
  year      = {2004},
  abstract  = {Hypertensive pregnancy disorders are a leading cause of perinatal and maternal morbidity and mortality. Heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS) are relevant predictors of cardiovascular risk in humans. The aim of the study was to evaluate whether HRV, BPV, and BRS differ between distinct hypertensive pregnancy disorders. Continuous heart rate and blood pressure recordings were performed in 80 healthy pregnant women as controls (CON), 19 with chronic hypertension (CH), 18 with pregnancy-induced hypertension (PIH), and 44 with pre-eclampsia (PE). The data were assessed by time and frequency domain analysis, nonlinear dynamics, and BRS. BPV is markedly altered in all three groups with hypertensive disorders compared to healthy pregnancies, whereby changes were most pronounced in PE patients. Interestingly, this increase in PE patients did not lead to elevated spontaneous baroreflex events, while BPV changes in both the other hypertensive groups were paralleled by alterations in baroreflex parameters. The HRV is unaltered in CH and PE but significantly impaired in PIH. We conclude that parameters of the HRV, BPV, and BRS differ between various hypertensive pregnancy disorders. Thus, distinct clinical manifestations of hypertension in pregnancy have different pathophysiological, regulatory, and compensatory mechanisms},
  language  = {en}
}
@book{MalbergSanderThoemmesWesseletal.2008,
  author    = {Malberg, Hagen and Sander-Th{\"o}mmes, Tilmann and Wessel, Niels and Wolf, Werner},
  title     = {Biosingnalverarbeitung : Innovation bei der Erfassung und Analyse bioelektronischer und biomagnetischer Signale ; Universit{\"a}t Potsdam, 16.-18.07.1000 ; Tagungsband},
  publisher = {Physikalische technische Bundesanst.},
  address   = {Potsdam},
  isbn      = {978-3-9810021-7-1},
  pages     = {205 S.},
  year      = {2008},
  language  = {de}
}
@article{HeringerWaltherMoreiraWesseletal.2005,
  author    = {Heringer-Walther, Silvia and Moreira, M. C. V. and Wessel, Niels and Saliba, J. L. and Silvia-Barra, J. and Pena, J. L. B. and Becker, S. and Siems, W. E. and Schultheiss, H. P. and Walther, T.},
  title     = {Brain natriuretic peptide predicts survival in Chagas' disease more effectively than atrial natriuretic peptide},
  issn      = {1355-6037},
  year      = {2005},
  language  = {en}
}
@article{ChenShiauTsengetal.2010,
  author    = {Chen, Jin-Long and Shiau, Yuo-Hsien and Tseng, Yin-Jiun and Chiu, Hung-Wen and Hsiao, Tzu-Chien and Wessel, Niels and Kurths, J{\"u}rgen and Chu, Woei-Chyn},
  title     = {Concurrent sympathetic activation and vagal withdrawal in hyperthyroidism : evidence from detrended fluctuation analysis of heart rate variability},
  issn      = {0378-4371},
  doi       = {10.1016/j.physa.2009.12.062},
  year      = {2010},
  abstract  = {Despite many previous Studies on the association between hyperthyroidism and the hyperadrenergic state, controversies still exist. Detrended fluctuation analysis (DFA) is a well recognized method in the nonlinear analysis of heart rate variability (HRV), and it has physiological significance related to the autonomic nervous system. In particular, an increased short-term scaling exponent alpha 1 calculated from DFA is associated with both increased sympathetic activity and decreased vagal activity. No study has investigated the DFA of HRV in hyperthyroidism. This study was designed to assess the sympathovagal balance in hyperthyroidism. We performed the DFA along with the linear analysis of HRV in 36 hyperthyroid Graves' disease patients (32 females and 4 males; age 30 +/- 1 years, means +/- SE) and 36 normal controls matched by sex, age and body mass index. Compared with the normal controls, the hyperthyroid patients revealed a significant increase (P < 0.001) in alpha 1 (hyperthyroid 1.28 +/- 0.04 versus control 0.91 +/- 0.02), long-term scaling exponent alpha 2 (1.05 +/- 0.02 versus 0.90 +/- 0.01), overall scaling exponent alpha (1.11 +/- 0.02 versus 0.89 +/- 0.01), low frequency power in normalized units (LF\%) and the ratio of low frequency power to high frequency power (LF/HF); and a significant decrease (P < 0.001) in the standard deviation of the R-R intervals (SDNN) and high frequency power (HF). In conclusion, hyperthyroidism is characterized by concurrent sympathetic activation and vagal withdrawal. This sympathovagal imbalance state in hyperthyroidism helps to explain the higher prevalence of atrial fibrillation and exercise intolerance among hyperthyroid patients.},
  language  = {en}
}
@article{CarvajalWesselVallverduetal.2005,
  author    = {Carvajal, R. and Wessel, Niels and Vallverdu, M. and Caminal, P. and Voss, Andreas},
  title     = {Correlation dimension analysis of heart rate variability in patients with dilated cardiomyopathy},
  issn      = {0169-2607},
  year      = {2005},
  abstract  = {A correlation dimension analysis of heart rate variability (HRV) was applied to a group of 55 patients with dilated cardiomyopathy (DCM) and 55 healthy subjects as controls. The 24-h RR time series for each subject was divided into segments of 10,000 beats to determine the correlation dimension (CD) per segment. A study of the influence of the time delay (tag) in the calculation of CD was performed. Good discrimination between both groups (p < 0.005) was obtained with tag values of 5 or greater. CD values of DCM patients (8.4 ± 1.9) were significantly lower than CD values for controls (9.5 ± 1.9). An analysis of CD values of HRV showed that for healthy people, CD night values (10.6 ± 1.8) were significant greater than CD day values (9.2 ± 1.9), revealing a circadian rhythm. In DCM patients, this circadian rhythm was lost and there were no differences between CD values in day (8.8 ± 2.4) and night (8.9 ± 2. 1). © 2005 Elsevier Ireland Ltd. All rights reserved},
  language  = {en}
}
@phdthesis{Wessel2005,
  author    = {Wessel, Niels},
  title     = {Data analysis and modeling of the cardiovascular system},
  address   = {Potsdam},
  pages     = {Getr. Z{\"a}hlung : graph. Darst.},
  year      = {2005},
  language  = {en}
}
@article{RetzlaffBauernschmittMalbergetal.2009,
  author    = {Retzlaff, Beatrice and Bauernschmitt, Robert and Malberg, Hagen and Brockmann, Gernot and Uhl, Christian and Lange, Ruediger and Kurths, J{\"u}rgen and Bretthauer, Georg and Wessel, Niels},
  title     = {Depression of cardiovascular autonomic function is more pronounced after mitral valve surgery : evidence for direct trauma},
  issn      = {1364-503X},
  doi       = {10.1098/rsta.2008.0272},
  year      = {2009},
  abstract  = {The analysis of baroreflex sensitivity (BRS) and heart rate variability (HRV) leads to additional insights into patients' prognosis after cardiovascular events. The following study was performed to assess the differences in the post-operative recovery of autonomic regulation after mitral valve (MV) and aortic valve (AV) surgery with a heart lung machine. Among the 43 consecutive male patients enrolled in a prospective study, 26 underwent isolated AV surgery and 17 isolated MV surgery. Blood pressure as well as ECG signals were recorded the day before, 24 hours after and one week after surgery. BRS was calculated according to the dual sequence method, and HRV was calculated using standard linear as well as nonlinear parameters. There were no major differences between the two groups in the pre-operative values. At 24 hours a comparable depression of HRV and BRS in both groups was observed, while at 7 days there was partial recovery in AV patients, which was absent in MV patients: p(AV versus MV) < 0.001. While the response of the autonomic system to surgery is similar in AV and MV patients, there is obviously a decreased ability to recover in MV patients, probably attributed to traumatic lesions of the autonomic nervous system by opening the atria. Ongoing research is required for further clarification of the pathophysiology of this phenomenon and to establish strategies to restore autonomic function.},
  language  = {en}
}
@article{HeringerWaltherMoreiraWesseletal.2006,
  author    = {Heringer-Walther, Silvia and Moreira, Maria da Consolacao V. and Wessel, Niels and Wang, Yong and Ventura, Pago Moreira and Schultheiss, Heinz-Peter and Walther, Thomas},
  title     = {Does the C-type natriuretic peptide have prognostic value in Chagas disease and other dilated cardiomyopathies},
  series = {Journal of cardiovascular pharmacology},
  volume    = {48},
  journal   = {Journal of cardiovascular pharmacology},
  number    = {6},
  publisher = {Lippincott Williams \& Wilkins},
  address   = {Philadelphia},
  issn      = {0160-2446},
  doi       = {10.1097/01.fjc.0000249892.22635.46},
  pages     = {293 -- 298},
  year      = {2006},
  abstract  = {Atrial natriuretic peptides (ANP) and brain natriuretic peptides (BNP) are powerful neurohormonal indicators of left-ventricular function and prognosis in heart failure (HF). Chagas disease (CD) caused by the protozoan Trypanosoma cruzi. remains a major cause of HF in Latin America. We assessed whether the plasma concentration of the third natriuretic peptide, C-type natnuretic peptide (CNP), also has diagnostic and prognostic properties in patients with CD or other dilated cardiomyopathies (DCM). Blood samples were obtained from 66 patients with CD, 50 patients with DCM from other causes, and 30 gender- and age-matched healthy subjects. Patients were subdivided according to the New York Heart Association (NYHA) class. The CNP concentration was determined by radioimmunoassay (Immundiagnostik, Bensheim, Germany). The main duration of follow-up was 31.4 months (range 13 to 54 months), 19 patients had died and 11 patients received a heart transplant. CNP concentrations were only significantly altered in patients with DCM or CD of the NYHA classes III and IV (P < 0.05). The Pearson correlation of echocardiographic data with CNP revealed an association only with the left-ventricular end systolic volume (P = 0.03) in patients with DCM. Furthermore, CNP did not predict mortality or the necessity for heart transplant. Our data are the first to demonstrate the raised levels of the third natriuretic peptide CNP in CD and other DCM Whereas ANP and BNP have a high predictive value for mortality in both diseases, CNP is without any predictive potency.},
  language  = {en}
}
@article{WesselSchumannWesseletal.2000,
  author    = {Wessel, Niels and Schumann, Agnes and Wessel, Niels and Schumann, Agnes and Schirdewan, Alexander and Voss, Andreas and Kurths, J{\"u}rgen},
  title     = {Entropy measures in heart rate variability data},
  year      = {2000},
  language  = {en}
}
@article{WesselVossKurthsetal.2000,
  author    = {Wessel, Niels and Voss, Andreas and Kurths, J{\"u}rgen and Schirdewan, Alexander and Hnatkova, Katarina and Malik, Marek},
  title     = {Evaluation of renormalised entropy for risk stratification using heart rate variability data},
  year      = {2000},
  abstract  = {Standard time and frequency parameters of heart rate variability (HRV) describe only linear and periodic behaviour, whereas more complex relationships cannot be recognised. A method that may be capable of assessing more complex properties is the non-linear measure of 'renormalised entropy.' A new concept of the method, RE(AR), has been developed, based on a non-linear renormalisation of autoregressive spectral distributions. To test the hypothesis that renormalised entropy may improve the result of high-risk stratification after myocardial infarction, it is applied to a clinical pilot study (41 subjects) and to prospective data of the St George's Hospital post- infarction database (572 patients). The study shows that the new RE(AR) method is more reproducible and more stable in time than a previously introduced method (p<0.001). Moreover, the results of the study confirm the hypothesis that on average, the survivors have negative values of RE(AR) (-0.11+/-0.18), whereas the non-survivors have positive values (0.03+/-0.22, p<0.01). Further, the study shows that the combination of an HRV triangular index and RE(AR) leads to a better prediction of sudden arrhythmic death than standard measurements of HRV. In summary, the new RE(AR) method is an independent measure in HRV analysis that may be suitable for risk stratification in patients after myocardial infarction.},
  language  = {en}
}
@article{BaumertBaierHaueisenetal.2004,
  author    = {Baumert, M. and Baier, V. and Haueisen, J. and Wessel, Niels and Meyerfeldt, Udo and Schirdewan, Alexander and Voss, Andreas},
  title     = {Forecasting of life threatening arrhythmias using the compression entropy of heart rate},
  issn      = {0026-1270},
  year      = {2004},
  abstract  = {Objectives. Ventricular tachycardia (VT) provoking sudden cardiac death (SCD) are a major cause of mortality in the developed countries. The most efficient therapy for SCID prevention are implantable cardioverter defibrillators (ICD). In this study heart rate variability (HRV) measures were analyzed for short-term forecasting of VT in order to improve VT sensing and to enable a patient warning of forthcoming shocks. Methods. The lost 1000 normal beat-to-beat intervals before 50 VT episodes stored by the ICD were analyzed and compared to individually acquire control time series (CON). HRV analysis was performed with standard parameters of time and frequency domain as suggested by the HRV Task Force and furthermore with a newly developed and optimized nonlinear parameter that assesses the compression entropy of heart rate (H-c). Results. Except of meanNN (p = 0.02) we found no significant differences in standard HRV parameters. In contrast, H, revealed highly significant (p = 0.007) alterations in VT compared with CON suggesting a decreased complexity before the onset of VT. Conclusion: Compression entropy might be a suitable parameter for short-term forecasting of life-threatening tachycardia in ICD},
  language  = {en}
}
@article{WesselMalberg2003,
  author    = {Wessel, Niels and Malberg, A.},
  title     = {Heart rate turbulence : an independent risk factor?},
  issn      = {1045-3873},
  year      = {2003},
  language  = {en}
}
@article{WesselMalbergWalther2004,
  author    = {Wessel, Niels and Malberg, Hagen and Walther, T.},
  title     = {Heart rate turbulence : higher predictive value than other risk stratifiers?},
  issn      = {0009-7322},
  year      = {2004},
  language  = {en}
}
@article{BauernschmittMalbergWesseletal.2004,
  author    = {Bauernschmitt, Robert and Malberg, Hagen and Wessel, Niels and Kopp, B. and Schirmbeck, E. U. and Lange, R.},
  title     = {Impairment of cardiovascular autonomic control in patients early after cardiac surgery},
  issn      = {1010-7940},
  year      = {2004},
  abstract  = {Objective: Impairment of the baroreceptor reflex activity reflects an alteration of the autonomous regulation of the cardiovascular system and has proven to predict fatal outcome in patients after acute myocardial infarction. The following study was performed to analyse the baroreceptor sensitivity, heart rate variability and blood pressure variability in patients early after coronary surgery. Methods: Twenty-five male patients undergoing coronary artery bypass were examined in a prospective study; normal values were obtained from healthy volunteers. Arterial pressure signals were recorded from a radial artery catheter for 30 min preoperatively and in short intervals after surgery. Mechanical manipulations and pharmacological interventions were avoided during the sampling periods. Baroreflex function was calculated according to the dual sequence method, heart rate variability and blood pressure variability were calculated including nonlinear methods. Results: Initial values of the patients did not differ from healthy volunteers. The strength of baroreflex sensitivity (increase in blood pressure causing a synchronous decrease of heart rate) is low 2 It postoperatively. The number of delayed tachycardic changes of heart rate, which are caused by sympathetic activation, is only moderately reduced as compared to values obtained from healthy volunteers. Heart rate variability is widely unchanged as compared to preoperative values; blood pressure variability showed an increase of low-frequency components, again indicating sympathetic predominance. Nonlinear analyses revealed reduced system complexity at the beginning of the postoperative course. Conclusion: Obviously, there is a vagal suppression 20 h after surgery, while the sympathetic tonus works in a normal range. This unbalanced interaction of the autonomous systems is similar to findings in patients after myocardial infarction. The predictive value of these markers has to be elucidated in further clinical studies. (C) 2003 Elsevier B.V. All rights reserved},
  language  = {en}
}
@article{HellandGapelyukSuhrbieretal.2010,
  author    = {Helland, Vanessa Carolina Figuera and Gapelyuk, Andrej and Suhrbier, Alexander and Riedl, Maik and Penzel, Thomas and Kurths, J{\"u}rgen and Wessel, Niels},
  title     = {Investigation of an automatic sleep stage classification by means of multiscorer hypnogram},
  issn      = {0026-1270},
  doi       = {10.3414/Me09-02-0052},
  year      = {2010},
  abstract  = {Objectives: Scoring sleep visually based on polysomnography is an important but time-consuming element of sleep medicine. Where-as computer software assists human experts in the assignment of sleep stages to polysomnogram epochs, their performance is usually insufficient. This study evaluates the possibility to fully automatize sleep staging considering the reliability of the sleep stages available from human expert sleep scorers. Methods: We obtain features from EEG, ECG and respiratory signals of polysomnograms from ten healthy subjects. Using the sleep stages provided by three human experts, we evaluate the performance of linear discriminant analysis on the entire polysomnogram and:only on epochs where the three experts agree in their-sleep stage scoring. Results: We show that in polysomnogram intervals, to which all three scorers assign the same sleep stage, our algorithm achieves 90\% accuracy. This high rate of agreement with the human experts is accomplished with only a small set of three frequency features from the EEG. We increase-the performance to 93\% by including ECG and respiration features. In contrast, on intervals of ambiguous sleep stage, the sleep stage classification obtained from our algorithm, agrees with the human consensus scorer in approximately 61\%. Conclusions: These findings suggest that machine classification is highly consistent with human sleep staging and that error in the algorithm's assignments is rather a problem of lack of well-defined criteria for human experts to judge certain polysomnogram epochs than an insufficiency of computational procedures},
  language  = {en}
}
@article{WesselRiedlKurths2009,
  author    = {Wessel, Niels and Riedl, Maik and Kurths, J{\"u}rgen},
  title     = {Is the normal heart rate "chaotic" due to respiration?},
  issn      = {1054-1500},
  doi       = {10.1063/1.3133128},
  year      = {2009},
  abstract  = {The incidence of cardiovascular diseases increases with the growth of the human population and an aging society, leading to very high expenses in the public health system. Therefore, it is challenging to develop sophisticated methods in order to improve medical diagnostics. The question whether the normal heart rate is chaotic or not is an attempt to elucidate the underlying mechanisms of cardiovascular dynamics and therefore a highly controversial topical challenge. In this contribution we demonstrate that linear and nonlinear parameters allow us to separate completely the data sets of the three groups provided for this controversial topic in nonlinear dynamics. The question whether these time series are chaotic or not cannot be answered satisfactorily without investigating the underlying mechanisms leading to them. We give an example of the dominant influence of respiration on heart beat dynamics, which shows that observed fluctuations can be mostly explained by respiratory modulations of heart rate and blood pressure (coefficient of determination: 96\%). Therefore, we recommend reformulating the following initial question: "Is the normal heart rate chaotic?" We rather ask the following: " Is the normal heart rate 'chaotic' due to respiration?"},
  language  = {en}
}
@phdthesis{Wessel1998,
  author    = {Wessel, Niels},
  title     = {Komplexe Analyse nichtlinearer Ph{\"a}nomene in kardiologischen Datenreihen},
  address   = {Potsdam},
  pages     = {123 Bl.},
  year      = {1998},
  language  = {de}
}
@article{RaabWesselSchirdewanetal.2006,
  author    = {Raab, Corinna and Wessel, Niels and Schirdewan, Alexander and Kurths, J{\"u}rgen},
  title     = {Large-scale dimension densities for heart rate variability analysis},
  issn      = {1539-3755},
  doi       = {10.1103/Physreve.73.041907},
  year      = {2006},
  abstract  = {In this work, we reanalyze the heart rate variability (HRV) data from the 2002 Computers in Cardiology (CiC) Challenge using the concept of large-scale dimension densities and additionally apply this technique to data of healthy persons and of patients with cardiac diseases. The large-scale dimension density (LASDID) is estimated from the time series using a normalized Grassberger-Procaccia algorithm, which leads to a suitable correction of systematic errors produced by boundary effects in the rather large scales of a system. This way, it is possible to analyze rather short, nonstationary, and unfiltered data, such as HRV. Moreover, this method allows us to analyze short parts of the data and to look for differences between day and night. The circadian changes in the dimension density enable us to distinguish almost completely between real data and computer-generated data from the CiC 2002 challenge using only one parameter. In the second part we analyzed the data of 15 patients with atrial fibrillation (AF), 15 patients with congestive heart failure (CHF), 15 elderly healthy subjects (EH), as well as 18 young and healthy persons (YH). With our method we are able to separate completely the AF (rho(mu)(ls)=0.97 +/- 0.02) group from the others and, especially during daytime, the CHF patients show significant differences from the young and elderly healthy volunteers (CHF, 0.65 +/- 0.13; EH, 0.54 +/- 0.05; YH, 0.57 +/- 0.05; p < 0.05 for both comparisons). Moreover, for the CHF patients we find no circadian changes in rho(mu)(ls) (day, 0.65 +/- 0.13; night, 0.66 +/- 0.12; n.s.) in contrast to healthy controls (day, 0.54 +/- 0.05; night, 0.61 +/- 0.05; p=0.002). Correlation analysis showed no statistical significant relation between standard HRV and circadian LASDID, demonstrating a possibly independent application of our method for clinical risk stratification},
  language  = {en}
}
@article{WesselAssmusWeidermannetal.2004,
  author    = {Wessel, Niels and Aßmus, Joerg and Weidermann, Frank and Konvicka, Jan and Nestmann, S. and Neugebauer, R. and Schwarz, Udo and Kurths, J{\"u}rgen},
  title     = {Modeling thermal displacements in modular tool systems},
  year      = {2004},
  abstract  = {In the last decade, there has been an increasing interest in compensating thermally induced errors to improve the manufacturing accuracy of modular tool systems. These modular tool systems are interfaces between spindle and workpiece and consist of several complicatedly formed parts. Their thermal behavior is dominated by nonlinearities, delay and hysteresis effects even in tools with simpler geometry and it is difficult to describe it theoretically. Due to the dominant nonlinear nature of this behavior the so far used linear regression between the temperatures and the displacements is insufficient. Therefore, in this study we test the hypothesis whether we can reliably predict such thermal displacements via nonlinear temperature-displacement regression functions. These functions are estimated firstly from learning measurements using the alternating conditional expectation (ACE) algorithm and then tested on independent data sets. First, we analyze data that were generated by a finite element spindle model. We find that our approach is a powerful tool to describe the relation between temperatures and displacements for simulated data. Next, we analyze the temperature-displacement relationship in a silent real experimental setup, where the tool system is thermally forced. Again, the ACE-algorithm is powerful to estimate the deformation with high precision. The corresponding errors obtained by using the nonlinear regression approach are 10-fold lower in comparison to multiple linear regression analysis. Finally, we investigate the thermal behavior of a modular tool system in a working milling machine and get again promising results. The thermally induced errors can be estimated with 1-2\${mu m}\$ accuracy using this nonlinear regression analysis. Therefore, this approach seems to be very useful for the development of new modular tool systems.},
  language  = {en}
}
@article{WesselVossMalbergetal.2000,
  author    = {Wessel, Niels and Voss, Andreas and Malberg, Hagen and Ziehmann, Christine and Voss, Henning U. and Schirdewan, Alexander and Meyerfeldt, Udo and Kurths, J{\"u}rgen},
  title     = {Nonlinear analysis of complex phenomena in cardiological data},
  year      = {2000},
  abstract  = {The main intention of this contribution is to discuss different nonlinear approaches to heart rate and blood pressure variability analysis for a better understanding of the cardiovascular regulation. We investigate measures of complexity which are based on symbolic dynamics, renormalised entropy and the finite time growth rates. The dual sequence method to estimate the baroreflex sensitivity and the maximal correlation method to estimate the nonlinear coupling between time series are employed for analysing bivariate data. The latter appears to be a suitable method to estimate the strength of the nonlinear coupling and the coupling direction. Heart rate and blood pressure data from clinical pilot studies and from very large clinical studies are analysed. We demonstrate that parameters from nonlinear dynamics are useful for risk stratification after myocardial infarction, for the prediction of life-threatening cardiac events even in short time series, and for modelling the relationship between heart rate and blood pressure regulation. These findings could be of importance for clinical diagnostics, in algorithms for risk stratification, and for therapeutic and preventive tools of next generation implantable cardioverter defibrillators.},
  language  = {en}
}
@article{WesselKleinerVossetal.1997,
  author    = {Wessel, Niels and Kleiner, H. J. and Voss, Andreas and Kurths, J{\"u}rgen and Dietz, R.},
  title     = {Nonlinear dynamics in cardiovasscular diseases},
  year      = {1997},
  language  = {en}
}
@article{BittmannGutschowLutheretal.2005,
  author    = {Bittmann, Frank and Gutschow, Stephan and Luther, Sven and Wessel, Niels and Kurths, J{\"u}rgen},
  title     = {On the functional relationship between postural motor balance and performance at school},
  year      = {2005},
  abstract  = {In integrated medical considerations of the biological human system, both intellectual and motor performances in a similar manner are considered as a result of the function of the nervous system. Consequently, universal minimal dysfunctions of the central nervous system may lead to both intellectual and physical anomalies. Therefore, this study tests the hypothesis that there is a connection between the balance ability as a motor parameter and school success as an intellectual parameter. A postural measuring system based on the force-moment sensor technique was used to record the postural balance regulation of 773 children (circle divide 11 +/- 1 years). The school achievement of each child was determined by school grades. Data analysis was performed by linear as well as by nonlinear time series analyses. There are highly significant differences in balance regulation between good and poor pupils recognized by several linear and nonlinear parameters. Good pupils could be discriminated from pupils with bad results in learning to 80 \%. The results support the hypothesis mentioned above. One possible explanation for the poor regulation of balance in bad learners could be a deficit in the neural maturity. In future, further developments will be targeted on higher discrimination levels, possibly in order to predict school success. On the other hand, the effects of special movement exercises on the neural development in childhood will be the focus in our further work},
  language  = {en}
}
@article{WesselKonvickaWeidermannetal.2004,
  author    = {Wessel, Niels and Konvicka, Jan and Weidermann, Frank and Nestmann, S. and Neugebauer, R. and Schwarz, U. and Wessel, A. and Kurths, J{\"u}rgen},
  title     = {Predicting thermal displacements in modular tool systems},
  issn      = {1054-1500},
  year      = {2004},
  abstract  = {In the last decade, there has been an increasing interest in compensating thermally induced errors to improve the manufacturing accuracy of modular tool systems. These modular tool systems are interfaces between spindle and workpiece and consist of several complicatedly formed parts. Their thermal behavior is dominated by nonlinearities, delay and hysteresis effects even in tools with simpler geometry and it is difficult to describe it theoretically. Due to the dominant nonlinear nature of this behavior the so far used linear regression between the temperatures and the displacements is insufficient. Therefore, in this study we test the hypothesis whether we can reliably predict such thermal displacements via nonlinear temperature-displacement regression functions. These functions are estimated firstly from learning measurements using the alternating conditional expectation (ACE) algorithm and then tested on independent data sets. First, we analyze data that were generated by a finite element spindle model. We find that our approach is a powerful tool to describe the relation between temperatures and displacements for simulated data. Next, we analyze the temperature-displacement relationship in a silent real experimental setup, where the tool system is thermally forced. Again, the ACE-algorithm is powerful to estimate the deformation with high precision. The corresponding errors obtained by using the nonlinear regression approach are 10-fold lower in comparison to multiple linear regression analysis. Finally, we investigate the thermal behavior of a modular tool system in a working milling machine and get again promising results. The thermally inducedaccuracy using this nonlinear regression analysis. Therefore, this approach seems to be very useful for the development of new modular tool systems. errors can be estimated with 1-2 micrometer},
  language  = {en}
}
@unpublished{KurthsVossWittetal.1994,
  author    = {Kurths, J{\"u}rgen and Voss, A. and Witt, Annette and Saparin, P. and Kleiner, H. J. and Wessel, Niels},
  title     = {Quantitative analysis of heart rate variability},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus-13470},
  year      = {1994},
  abstract  = {In the modern industrialized countries every year several hundred thousands of people die due to the sudden cardiac death. The individual risk for this sudden cardiac death cannot be defined precisely by common available, non-invasive diagnostic tools like Holter-monitoring, highly amplified ECG and traditional linear analysis of heart rate variability (HRV). Therefore, we apply some rather unconventional methods of nonlinear dynamics to analyse the HRV. Especially, some complexity measures that are basing on symbolic dynamics as well as a new measure, the renormalized entropy, detect some abnormalities in the HRV of several patients who have been classified in the low risk group by traditional methods. A combination of these complexity measures with the parameters in the frequency domain seems to be a promising way to get a more precise definition of the individual risk. These findings have to be validated by a representative number of patients.},
  language  = {en}
}
@article{WesselMarwanMeyerfeldtetal.2001,
  author    = {Wessel, Niels and Marwan, Norbert and Meyerfeldt, Udo and Schirdewan, Alexander and Kurths, J{\"u}rgen},
  title     = {Recurrence quantification analysis to characterise the heart rate variability before the onset of ventricular tachycardia},
  year      = {2001},
  abstract  = {Ventricular tachycardia or fibrillation (VT) as fatal cardiac arrhythmias are the main factors triggering sudden cardiac death. The objective of this recurrence quantification analysis approach is to find early signs of sustained VT in patients with an implanted cardioverter-defibrillator (ICD). These devices are able to safeguard patients by returning their hearts to a normal rhythm via strong defibrillatory shocks; additionally, they are able to store at least 1000 beat-to-beat intervals immediately before the onset of a life-threatening arrhythmia. We study the},
  language  = {en}
}
@article{MarwanWesselMeyerfeldtetal.2002,
  author    = {Marwan, Norbert and Wessel, Niels and Meyerfeldt, Udo and Schirdewan, Alexander and Kurths, J{\"u}rgen},
  title     = {Recurrence-plot-based measures of complexity and its application to heart-rate-variability data},
  year      = {2002},
  abstract  = {The knowledge of transitions between regular, laminar or chaotic behavior is essential to understand the underlying mechanisms behind complex systems. While several linear approaches are often insufficient to describe such processes, there are several nonlinear methods which however require rather long time observations. To overcome these difficulties, we propose measures of complexity based on vertical structures in recurrence plots and apply them to the logistic map as well as to heart rate variability data. For the logistic map these measures enable us not only to detect transitions between chaotic and periodic states, but also to identify laminar states, i.e. chaos-chaos transitions. The traditional recurrence quantification analysis fails to detect the latter transitions. Applying our new measures to the heart rate variability data, we are able to detect and quantify the laminar phases before a life-threatening cardiac arrhythmia occurs thereby facilitating a prediction of such an event. Our findings could be of importance for the therapy of malignant cardiac arrhythmias.},
  language  = {en}
}
@article{StepanFaberWesseletal.2006,
  author    = {Stepan, H and Faber, R and Wessel, Niels and Wallukat, Gerd and Schultheiss, H. P. and Walther, T},
  title     = {Relation between circulating angiotensin II type 1 receptor agonistic autoantibodies and soluble fms-like tyrosine kinase 1 in the pathogenesis of preeclampsia},
  doi       = {10.1210/Jc.2005-2698},
  year      = {2006},
  abstract  = {Context: Placental and circulatory soluble fms-like tyrosine kinase 1 (sFlt1) has proven to be elevated in pregnant women with preeclampsia, a disease characterized by hypertension, proteinuria, and endothelial dysfunction. Recent studies also demonstrated an autoantibody against the angiotensin II type 1 (AT1) receptor (AT1-AA) in that disease. Objective: Both factors are discussed as key players in the etiology of preeclampsia. However, it has not yet been clarified whether these two circulating factors correlate and whether synergy determines the severity of pathology. Design: AT1-AA was retrospectively determined by a bioassay and sFlt1 by an ELISA. Patients: Serum from second-trimester pregnancies with normal or abnormal uterine perfusion and in women at term with or without pregnancy pathology was analyzed. Results: Most of the preeclamptic patients were characterized by high sFlt1 levels and the presence of AT1-AA, although the agonistic effects of the antibody did not correlate with the sFlt1 concentrations (P = 0.85). Although AT1- AA was also detected in second-trimester pregnancies evidencing abnormal uterine perfusion without later pathology, sFlt1 was not significantly elevated in these pregnancies, compared with those with normal uterine perfusion. However, whereas women with abnormal perfusion and later pregnancy pathology did not differ in AT1-AA, compared with those with normal outcome, sFlt1 was significantly increased. Again, the two factors did not correlate (P = 0.15). Conclusions: We conclude that AT1-AA bioactivity and sFlt1 concentrations do not correlate, are not mutually dependent, and are thus probably involved in distinct pathogenetic mechanisms. Both factors in combination may not be causative for the early impaired trophoblast invasion and pathological uterine perfusion},
  language  = {en}
}
@article{WesselZiehmannKurthsetal.2000,
  author    = {Wessel, Niels and Ziehmann, Christine and Kurths, J{\"u}rgen and Meyerfeldt, Udo and Schirdewan, Alexander and Voss, Andreas},
  title     = {Short-term forecasting of life-threatening cardiac arrhythmias based on symbolic dynamics and finite-time growth rates},
  year      = {2000},
  abstract  = {Ventricular tachycardia or fibrillation (VT-VF) as fatal cardiac arrhythmias are the main factors triggering sudden cardiac death. The objective of this study is to find early signs of sustained VT-VF in patients with an implanted cardioverter-defibrillator (ICD). These devices are able to safeguard patients by returning their hearts to a normal rhythm via strong defibrillatory shocks; additionally, they store the 1000 beat-to-beat intervals immediately before the onset of a life-threatening arrhythmia. We study these 1000 beat-to-beat intervals of 17 chronic heart failure ICD patients before the onset of a life-threatening arrhythmia and at a control time, i.e., without a VT-VF event. To characterize these rather short data sets, we calculate heart rate variability parameters from the time and frequency domain, from symbolic dynamics as well as the finite-time growth rates. We find that neither the time nor the frequency domain parameters show significant differences between the VT-VF and the control time series. However, two parameters from symbolic dynamics as well as the finite-time growth rates discriminate significantly both groups. These findings could be of importance in algorithms for next generation ICD's to improve the diagnostics and therapy of VT-VF.},
  language  = {en}
}
@article{WesselSchwarzSaparinetal.2002,
  author    = {Wessel, Niels and Schwarz, Udo and Saparin, Peter and Kurths, J{\"u}rgen},
  title     = {Symbolic dynamics for medical data analysis},
  isbn      = {3-936142-09-2},
  year      = {2002},
  abstract  = {Observational data of natural systems, as measured in medical measurements are typically quite different from those obtained in laboratories. Due to the peculiarities of these data, wellknown characteristics, such as power spectra or fractal dimension, often do not provide a suitable description. To study such data, we present here some measures of complexity, which are basing on symbolic dynamics. Firstly, a motivation for using symbolic dynamics and measures of complexity in data analysis based on the logistic map is given and next, two applications to medical data are shown. We demonstrate that symbolic dynamics is a useful tool for the risk assessment of patients after myocardial infarction as well as for the evaluation of th e architecture of human cancellous bone.},
  language  = {en}
}
@article{RiedlvanLeeuwenSuhrbieretal.2009,
  author    = {Riedl, Maik and van Leeuwen, Peter Jan and Suhrbier, Alexander and Malberg, Hagen and Groenemeyer, Dietrich and Kurths, J{\"u}rgen and Wessel, Niels},
  title     = {Testing foetal-maternal heart rate synchronization via model-based analyses},
  issn      = {1364-503X},
  doi       = {10.1098/rsta.2008.0277},
  year      = {2009},
  abstract  = {The investigation of foetal reaction to internal and external conditions and stimuli is an important tool in the characterization of the developing neural integration of the foetus. An interesting example of this is the study of the interrelationship between the foetal and the maternal heart rate. Recent studies have shown a certain likelihood of occasional heart rate synchronization between mother and foetus. In the case of respiratory-induced heart rate changes, the comparison with maternal surrogates suggests that the evidence for detected synchronization is largely statistical and does not result from physiological interaction. Rather, they simply reflect a stochastic, temporary stability of two independent oscillators with time-variant frequencies. We reanalysed three datasets from that study for a more local consideration. Epochs of assumed synchronization associated with short-term regulation of the foetal heart rate were selected and compared with synchronization resulting from white noise instead of the foetal signal. Using data-driven modelling analysis, it was possible to identify the consistent influence of the heartbeat duration of maternal beats preceding the foetal beats during epochs of synchronization. These maternal beats occurred approximately one maternal respiratory cycle prior to the affected foetal beat. A similar effect could not be found in the epochs without synchronization. Simulations based on the fitted models led to a higher likelihood of synchronization in the data segments with assumed foetal-maternal interaction than in the segment without such assumed interaction. We conclude that the data-driven model-based analysis can be a useful tool for the identification of synchronization.},
  language  = {en}
}
@article{WesselSchirdewan2006,
  author    = {Wessel, Niels and Schirdewan, Alexander},
  title     = {Toward a prediction of sudden death in propofol-related infusion syndrome},
  year      = {2006},
  language  = {en}
}